Prediction Analysis of Esophageal Variceal Degrees using Data Mining: Is Validated in Clinical Medicine?

The objective of this study is to assess the feasibility of a data mining association analysis technique in early prediction of esophageal varices in cirrhotic patients and prediction of risky groups candidates for urgent interventional procedure. A manuscript titled 201C;Detection of Risky Esophageal varices using 2D U/S: when to perform Endoscopy201D;, published in The American Journal of The Medical Science on 21Th of December 2012, to our knowledge it was the first prospective study to assess the degree of esophageal varices by 2D ultrasound using the data mining statistical computed analysis in 673 patients. A descriptive model was generated using a decision tree algorithm (Rapid Miner, version 4.6, Berlin, Germany), the over all accuracy was 95%. Following another 59 patients using statistical analysis to determine the association between esophageal variceal degrees detected by Ultrasound in comparable to Upper Endoscopy, was done. Categorical data were compared using the x2 test, where as continuous variables were compared using Student2019;s t test. The comparative results accuracy of both two studies was 97.9%

Effect of Sickle Cell Crises Prevention Guide for Children on Parents Knowledge and Reported Practices

Sickle cell anemia (SCA) is a global health concern associated with high childhood morbidity and mortality. The major associated complication is sickle cell crisis which cause frequent hospital admission. Therefore, the purpose of this study was to examine the effect of sickle cell crises prevention guide for children on parents’ knowledge and reported practices. The study was conducted at Hematology & oncology unit of Pediatric department at Menoufia University Hospital and Health insurance hospital for children.  A quazi experimental design was used. A convenient sample of parents with sickle cell children in the above mentioned settings were selected (34 parents) from January to November 2018. One tool was used for data collection consists of 4-sections questionnaire to assess parents' knowledge and practice. The results of this study revealed that there were knowledge deficit between parents' about sickle cell disease, approximately two thirds of parents (64.7%) had improved on post intervention for reported practices of crisis prevention than pre intervention. Also, 79.4% of parents didn’t use social and cultural practices in prevention of sickle cell crises post intervention. Therefore, there was a highly statistical significance differences between pre and post intervention. Conclusion, implementing sickle cell prevention guide improve parents’ knowledge and reported practices for prevention of crises to promote children recovery. Recommendation, ensure that sickle cell booklets are made available to hospitals for parents in order to remind themselves on treatment and prevention of sickle cell crises. Keywords: Sickle cell crisis, knowledge, Practice DOI: 10.7176/JHMN/64-07 Publication date:July 31st 201

Effect of ABCB1 (3435C>T) and CYP3A5 (6986A>G) genes polymorphism on tacrolimus concentrations and dosage requirements in liver transplant patients

AbstractBackgroundTacrolimus (TAC) is an immunosuppressant used in organtransplant recipients. It is a substrate of drug transporter ABCB1 as well as of cytochrome P4503A (CYP3A).AimTo assess the influence of ABCB1 (3435 C>T) and CYP3A5 (6986 A>G) genes polymorphism of liver transplant donors and recipients on blood level and dose requirements of oral tacrolimus, to help in designing an individualized tacrolimus regimen for liver transplant recipients.Subjects and methodsForty-eight adult liver transplant recipients and their matching living donors were prospectively enrolled in this study. TAC doses and blood concentration were recorded on 1st, 2nd and 3rd days, after 1 and 2weeks, and at 1, 3 and 6months postoperatively using ultra performance liquid chromatography Tandem mass spectrometry. Genotyping of ABCB1 (3435C>T) and CYP450 3A5 (6986A>G) genes were determined by Polymerase chain reaction followed by restriction fragment length polymorphism and by TaqMan allelic discrimination assay techniques, respectively.ResultsOf the enrolled 48 recipients, CYP3A5∗3/∗3 and CYP3A5∗1/∗3 genotypes were detected in 18 (37.5%) and in 20 (41.7%) recipients respectively, while ABCB1 CT and TT genotypes were detected in16 (33.3%) and 10 (20.8%) recipients respectively. TAC daily dose was significantly increased among recipients carrying ABCB1 CC genotype compared to recipients carrying CT and TT genotypes during and after the first month postoperatively. During 1st, 2nd days and 2weeks post-transplant, a significant increase of TAC concentration / dose ratio was observed among recipients carrying CYP3A5∗3∗3 genotype than recipients carrying 1∗1∗ and 1∗3∗ genotypes, and among recipients carrying ABCB1 CT and TT genotypes compared to those carrying CC genotype on 1st, 3rd days and at 3months postoperatively.ConclusionsABCB1 and CYP3A5 genetic polymorphism is one of the factors influencing TAC pharmacokinetics, screening for these SNPs prior to liver transplantation might be helpful for individualization of tacrolimus treatment

Phenol removal from aqueous solutions by using H-mordenite and platinum supported H-mordenite

H-Mordenite and platinum supported H-mordenite were prepared and tested to remove phenol from aqueous solutions. The supported mordenite was prepared using wet impregnation method. The physicochemical properties of these prepared samples were characterized by several techniques such as SEM, HR-TEM, X-ray diffraction and N2 adsorption. The effects of temperature, pH, phenol concentration, catalyst amount and UV at 254 nm were studied to obtain the optimum conditions at which best removal occurs. It was seen that the removal using H-mordenite is close to the supported H-mordenite

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe